VA,

It is our great pleasure to inform you that the efforts you made to alert the VA to problems with the agency's proposed rule expanding the authority for APRNs to "perform and supervise" laboratory testing has met with success.

We have successfully convinced the VA to adjust the language to better protect patients while expanding access to care for our nation’s veterans. Further, the VA calls out the "crucial role" laboratorians play in the care of VA patients. The key language explaining this change is below (with our emphasis added).

“Several commenters stated that they were concerned with proposed § 17.415(d)(1)(i)(B), where we stated that a Certified Nurse Practitioner (CNP) may order, perform, or supervise laboratory studies. The commenters stated that the proposed language does not “adequately appreciate the levels of complexity involved in laboratory testing” and that there are rigid standards for laboratory tests that require rigorous academic and practical training, which are not part of the training for APRNs. Another commenter stated, “While the VHA uses the word ‘interpret’ in reference to laboratory and imaging studies,” the commenter “…infers that the VA’s intent is to grant the ability for CNPs to interpret laboratory and imaging results, not to interpret or report raw images or data.” The commenter suggested that VA amend the term “‘interpret’ and recommends instead to use ‘integrate results into clinical decision making,’ or some other phrase” in order to avoid confusion between the duties of an APRN and those of a laboratory specialist. We agree with the commenter in that the proposed language might be construed as allowing CNPs the ability to perform laboratory studies. It is not VA’s intent to have APRNs take over the role of laboratory specialists. These specialists perform a crucial role at VA medical facilities and are skillfully trained in performing the various testing techniques that allow health care professionals to properly treat a veteran’s medical condition. We are amending proposed § 17.415(d)(1)(i)(B) to now state that a CNP may be granted full practice authority to ‘Order laboratory and imaging studies and integrate the results into clinical decision making.’”

Congratulations to everyone who worked so hard and with so much passion to address this issue!